Weghorst, A. (Anouk) (2019) Opportunities for reducing referrals in children with acute gastroenteritis in primary care: a mixed-methods study :‘Increasing parental and general practitioner knowledge about acute gastroenteritis could potentially reduce the number of referrals’. thesis, Medicine.
Full text available on request.Abstract
Introduction Acute gastroenteritis (AGE) is a common childhood disease in primary care. Most of the time it is an uncomplicated disease with good treatment options. The most common complication is dehydration and that is an important reason for referral to secondary care. It is assumed that too many children with a low risk of dehydration are referred to the hospital. Insight in the reasons for referral could potentially reduce the number of referrals and consequently hospitalizations. Method In this mixed-methods study we investigated the medical files of 39 children, aged six months to six years diagnosed with AGE by the general practitioner (GP) who were referred to the hospital. After determining the preventable and unpreventable referrals with qualitative analysis, the characteristics of these two groups were compared with quantitative analysis. Results Of the 39 included children who were referred to the hospital, 23 (59,0%) were consequently hospitalized. We defined three categories in which referrals could have been prevented. The themes we found for the children in the no medical referral category were no signs of dehydration, end of disease episode and concerned parents. Themes in the no dehydration referral category were vulnerable child, several GP visits and atypical course of AGE. The themes in the category no high-risk referral were good response to a dose of ondansetron and balancing, load capacity and care demand for children. We defined the unpreventable referrals as the children who received dehydration treatment for which a hospital admission was required, namely rehydration by a nasogastric tube. Themes we defined for this were several dehydration signs, not enough response to oral rehydration therapy (ORT), reduced intake and ongoing losses. Children in the unpreventable referral group showed signs of an extended capillary refill time (22,2%) and sunken eyes (11,1%) while no child in the preventable referral group showed this. In the preventable referral group, 50,0% of the children did not receive liquids for more than 12 hours compared to 10,0% in the preventable referral group. Conclusion Based on the qualitative and quantitative analysis we found opportunities from the perspective of paediatricians that could possible reduce the number of referrals and consequently hospitalizations. These opportunities are increasing parental knowledge about AGE, providing sufficient amounts of liquids to the child, properly assessing the clinical signs of dehydration, evaluating the course of the disease and assessing the response to ORT.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Holtman, Dr. G.A. and Berger, Prof. Dr. M.Y. and Department of General Practice and University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/415 |
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